The result of the analysis of the obtained data was 2172 initial or open code. After removing the unrelated codes and merging some of the codes, the initial categories and finally the original categories were obtained. Synergistic building safety deficiency and qualitative relief defects were identified as the core category as the center of this study. This reflects participants' experience essence on the barriers to preventing fire related injuries in residential areas in Iran. These issues are debatable at various levels, from local and national policy to individual characteristics and behaviors of people and inhabitants of residential buildings against fires.
Causal Conditions
In this study, Causal Conditions are events or phenomena that results in the creation or severity of an injury resulting from a fire or a reduction in the safety of residential buildings inhabitants. Unsafe buildings against fire, individual risk characteristics and behaviors are major barriers to the safety of inhabitants of residential buildings against fire.
(A) Individual hazardous features and behaviors
According to the participants, lack of belief in safety and a low understanding of fire risk and the resulting injuries are among the most important factors in the creation and spread of fire as well as the injuries caused by it among inhabitants' residential buildings that are considered as barriers to safety.
"Most of us think that these events are for others and we do not believe it. And unfortunately, we believe it when we get injured. Also, we are willing to spend thousands of dollars on surgery for burning scars, but we are not willing to spend less money on preventing it. Because we do not know the importance of it" (P15).
"We had a case that a mother put the baby sleep next to the heater after bathing and one side of the blanket was on the heater and the other side of it was thrown over the baby to warm her baby and she went out of the room" (P 19).
Human behavior during fires is the most important aspect of safety in the residents of the building. Dangerous behavior and unsafe lifestyle of residents living in residential buildings due to their low attitude towards safety are among the most important risk factors for their health and also one of the barriers to fire related injuries prevention.
"The mistake that is made during a fire is that when the detector declares a fire, we try to extinct it, in case we should save ourselves. Because without informing the firefighter it may waste the time and jeopardize our lives" (P 12). Another surprising case happened in 2017 was the use of gas cylinders to open the sewer pipe by a number of people, which caused gas leakage in several floors and a huge fire ..." (P15).
B) Unsafe Buildings
The experiences of participants in this study suggest that the weakness in the structure of residential buildings can prevent the safety of residents of these buildings against fire and the resulting injuries.
Inappropriate interior design, such as: lack of emergency exit paths, lack of design and installation of fire warning systems and the use of unsafe and low-quality building materials, are among the safety barriers for inhabitants of residential buildings against fire.
"... We give an example inside a residential complex about 3 years ago, and one of the drawbacks that caused the spread of fire was that the elevator and the staircase were in one place beside. The building also had no escape stairs and fireproof doors ..." (P8).
".... Another obstacle is the lack of maintenance of fire extinguishing and warning systems in buildings that cannot be served when they are needed, residents unplug them because of smoking..." (P5).
"…. We often see that in construction of the roof of newly built houses Styrofoam are used that are rapidly expanding due to fire and it is accompanied by a lot of smoke that not only causes the spread of fire but also it has suffocating smoke for residents ..." (P6)
Contextual Conditions
Contextual conditions are a series of conditions that create situations or problems through which groups or individuals respond by their actions/interactions (19, 24).The Participants described some underlying factors that influenced a systematic safety process from fire related injuries and also the choice of strategy. "The weakness of the safety culture",” Legislation and oversight defect", "Lack of awareness” and "insufficient economic support" are among the underlying conditions in this study.
A) The weakness of safety culture
Based on the experience gained, the culture of the people is such that people pay a lot of attention to decorating the home and put safety in next priority. The installation of flammable fixtures and furniture inside residential buildings near the heating equipment can spread the fire and increase the injuries.
"...... We went in a residential complex to firefighting operations, a stove was clinging to the table and there was a cloth on the table, which that could cause fire...." (P4).
B) Legislation and oversight defect
Most contributors consider the inadequate laws and supervision of building safety as a cause of fires. According to Participants' opinion, legislation to improve safety of buildings has been less considered by policy makers,
"... Fire alarm and extinguishing systems that should be in all buildings only in buildings above 5 floors is mandatory in our country, and this requirement is only demanded until the end of the construction, and thereafter there is no supervision..." (P1).
"... To save the economy, building manufacturers will ignore safety systems, and even Building buyers do not pay attention to the fact whether buildings have safety systems or not" (P15).
C) Lack of awareness
The participants described that safety defect is one of the most important concepts that influenced the fire process and it means that knowledge, skills and safety literacy of people in the field of safety are inadequate. So that lack of education, insufficient knowledge and information in occupants of residential buildings can have a negative effect on their behavior during the fire and cause increased damage and injuries.
"... Most people do not know how to deal with the fires and the related safety tips. Unfortunately, there is little education because of the safety topics are not a priority of our lives ..." (P3).
D) Insufficient Economic Support
Another important issue in Iran is economic issues that contributed to the safety of occupants of building. Many contributors have said that the use of cheaper equipment, which has a lower quality, will reduce the safety of occupants against fires.
"... constructing a standard building imposes a lot of costs on manufacturers, and manufacturers try to ignore safety systems, and even our buyers do not pay attention to the fact whether their building have safety systems or not" (P15).
Intervening Conditions
These conditions either facilitate or constrain the action/interactional strategies taken within a specific context (24). Factors, such as an increasing number of injuries and providing free-of-charge hospital trauma care for RTIs victims could be seen as intervening conditions.
In this study, the intervening conditions are a vast field of structure that influences the safety of inhabitants of residential buildings against fire. These conditions either accelerates or restricts the implementation of the strategies taken within a specific context (24). The weakness in accident management, the inadequacy of skills and equipment of relief forces, and lack of access to the site of the accident are among the factors that challenge the effectiveness of relief and rescue services. Also, poor coordination of relief and work interference between relief service providers that provide services simultaneously (firefighters, pre-hospital and police service providers), can exacerbate injuries, waste of time and increase the cost of relief to make.
Weakness of Incident Scene Management
This category refers to problems due to management weakness in scene of the accident and relief workers causing disturbance in the delivery of relief forces such as fire department and pre-hospital emergency.
"... We are prepared as pre-hospital emergency forces in front of the building to help the injured people, but firefighters took injured out from the back of the building. We do not have a common language for coordination. ..." (P1).
Inadequate Skills and Equipment of the Relief Forces
According to the experiences of the participants, lack of operational skills, as well as inadequate and not up-to-date equipment of the operational teams, will make it difficult to provide relief to the injured.
".... Our firefighters who are able to enter the hot zone do not have enough knowledge to rehabilitate and treat the injured because they lack medical knowledge...." (P1).
"... Many injured people should be taken to medical care centers in hot zone, but the pre-hospital emergency forces do not have these fire safety equipment and tools, even an ambulance that can enter the area. Because of the inability to enter the area, we have a higher mortality rate" (P1).
Lack of Access to the incident areas
This refers to the obstacles that impede the timely arrival of firefighters on incident areas and the provision of favorable relief services to the injured.
"... Among the barriers to the relief of firefighters are the problem accessing to the incident areas, such as tight passageways, in-city electric wires, some green spaces and trees front of buildings, preventing the transfer of our equipment. For example, they give permission to building construction at six-meter passage" (P26).
Actions / Interaction Strategies
Action/interaction strategies are purposeful or deliberate course of actions, which are taken by individuals or groups in response to events, problems or issues which occur under certain conditions (24).
Action/interaction strategies include targeted and planned actions that are addressed by individuals or groups in response to events, problems or issues that occur under certain situations (24). Contributors explained that various actors involved in the safety of inhabitants of residential buildings respond in different ways to factors affecting fire related injuries. They used a set of approaches and measures to face Synergic defects of building safety and relief quality. These actions were called “Scramble for safety against fire related injuries", which included both adaptive and maladaptive strategies.
A) Adaptive strategies
These strategies were responses and efforts made by individuals or groups against synergic defects of building safety and relief quality, and ultimately for the safety of themselves and others against fire related injuries.
The adaptive strategies consisted of five sub-categories: self-protection, getting help from rescue forces, equipping buildings with safety devices, judicial approach with inhabitants of unsafe buildings and trying to upgrade relief services.
Self-protection and getting help from rescue forces
According to most contributors, one of the ways to increase the safety and prevention of fire-related injuries in residential buildings is to protect themselves against fire and announcing to the relief forces, especially firefighters and pre-hospital emergency departments.
"In case of a fire, the first duty of residents is to evacuate the building and remove themselves and the family members, especially people with disabilities. The second task is announcing to the fire department and other relief forces such as the emergency and if we do not have escape way, we have to go to the roof so that the relief forces can save us through it" (P1).
Equipping the Building with Safety devices
Based on the findings, one of the strategies used by people to provide safety from fire related injuries was to equip the building with safety devices such as fire extinguishers and fire detection systems, which is one of the concepts derived from this study.
"... After experiencing a fire, we learned a lot: one was that we did not have any firefighting equipment at home, but after that we bought a fire extinguisher and one Co2 capsule for electrical fires ..." (P22).
Judicial approach with inhabitants of unsafe buildings
judicial collision with inhabitants and owners of buildings that their buildings were unsafe to fire was an effective strategy used by fire safety supervisors.
" After visiting more than 200 buildings, we sent a written note for buildings owners that their buildings had a safety problem. Then, in cooperation with the judiciary, sent warning letter to resolve the safety problems. So, they were required to resolve the problem and make their buildings safer than in the past ..." (P26).
Trying to promote of relief services
The efforts that relief agencies were undertaking to promote relief services to reduce the weakness of fire prevention and, ultimately, to safety promotion of people against fire related injuries.
".... After fires that we feel we have weakness, we have meetings with to fix those weaknesses and, as far as our affordability allows, we started to buy firefighting equipment. ..." (P26).
"..... After the special fires that we are weak, we will have meetings with the operational commanders to resolve those weaknesses and, as far as our financial matters allow us, we will purchase firefighting equipment." (P26).
B) Maladaptive response
some people show reactions against synergic defects of building safety and relief quality, which endangers their health. These proceedings were classified as maladaptive responses. The maladaptive response includes; surrendering to the problem or ignoring them, as well as inappropriate actions and responses described below:
Surrendering / Fatalism
Based on the experiences and understanding of participants, giving up and not paying attention to preventive approaches increases the likelihood of injuries.
"... Fatalism cause disregard for prevention. We have to raise our skills and this is not possible except by destroying the culture of fatalism. If I'm not a fatalist, I will not abandon my house with God's protection and for that I will create safety solutions ...." (P1).
Inappropriate actions and responses
According to the experience of participants, fire extinguishing without the necessary equipment and skills as well as doing hazardous measures to escape, can increase the risks of building fire and injuries related to them.
".... The fires that I experienced was very intense and terrible, I proceeded to fire extinguishing without any firefighting equipment and I got burned, because without experience, I tried to put it off ...." (P22).
Consequences
The consequences are derived from the use of action / interaction strategies chosen by actors (24). The strategies employed by different actors involved in the safety of fire related injuries to residential buildings have created the implications that the study called "scramble for safety against fire related injuries" which included both adaptive and maladaptive strategies.
Safe building against fire and changing to living safely of fire are adaptive strategies that have been extracted from contributors' experiences. On the other hand, the maladaptive strategies are other types of consequences that consist of two sub-categories: physical and mental injury and financial damage.
"... After experiencing a fire, we avoided from any danger especially fire and if I see a fire, according to the previous experience, I don’t become nervous and will do better. We also removed the Gas cylinder from the home appliances. We removed all flammable materials from houses ..." (P22).
"... This injury that I saw will never be compensated for me and I have lost my spirit. I'm very anxious and stressed. I'm afraid of the match. A while ago, a gentleman wanted to smoke, I was anxious and scared, and I became unconscious...." (P19).